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DigitalCommons@Liberty University Faculty Publications and Presentations

Center for Counseling and Family Studies

Fall 9-24-2009

Attachment: The Antidote to Trauma Joshua Straub Liberty University, [email protected]

Follow this and additional works at: http://digitalcommons.liberty.edu/ccfs_fac_pubs Part of the Biological Psychology Commons, Child Psychology Commons, Clinical and Medical Social Work Commons, Clinical Psychology Commons, Cognition and Perception Commons, Cognitive Psychology Commons, Community Health Commons, Community Psychology Commons, Developmental Psychology Commons, Health Psychology Commons, Industrial and Organizational Psychology Commons, Marriage and Family Therapy and Counseling Commons, Other Mental and Social Health Commons, Other Psychology Commons, Personality and Social Contexts Commons, Psychiatric and Mental Health Commons, Psychoanalysis and Psychotherapy Commons, Social Psychology Commons, Social Work Commons, and the Substance Abuse and Addiction Commons Recommended Citation Straub, Joshua, "Attachment: The Antidote to Trauma" (2009). Faculty Publications and Presentations. Paper 51. http://digitalcommons.liberty.edu/ccfs_fac_pubs/51

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Attachment: The Antidote to Trauma Joshua Straub, Ph.D.

Objectives
Demonstrate the importance of the therapeutic relationship

in helping traumatized clients, particularly those diagnosed with PTSD, overcome trauma-related symptoms
Demonstrate how strategies such as meditation, mindfulness, and mentalizing are utilized in helping clients integrate traumatic experiences with their emotions and beliefs
Develop an effective strategy for helping trauma victims gain attachment security and therefore engage in healthy relationships with their family and with God

A range of disciplines
Neurobiology
Developmental psychology
Traumatology
Systems theory

Factors to Trauma
Identified risk factors of early adverse life experiences
Peritraumatic dysregulation (hyperarousal and dissociation)
Posttraumatic social support difficulties

The Johns Hopkins’ RESISTANCE, RESILIENCE, RECOVERY

An outcome-driven continuum of care

Create Resistance Assessment Intervention Evaluation

Enhance Resiliency Assessment Intervention Evaluation

Speed Recovery Assessment Intervention Evaluation

[Kaminsky, et al, (2005) RESISTANCE, RESILIENCE, RECOVERY. In Everly & Parker, Mental Health Aspects of Disaster: Public Health Preparedness and Response. Balto: Johns Hopkins Center for Public Health Preparedness.

Attachment Theory
How relationships shape our brains ability to regulate

emotion and learn to participate in close, intimate relationships
Emotion regulation is the ability to tolerate and manage strong negative emotions and to experience the wide range of positive emotions as well
Key question: “Is this world I’m living in a safe or dangerous place?
Forms basis for what Bowlby described as Internal Working Model

Core “Relationship” Beliefs Self

Other

•Am I worthy? •Am I capable?

•Are you reliable? •Are you accessible? •Are you capable? •Are you willing?

Internal Working Models
Self – Am I worthy of love?
Other – Are others reliable? Trustworthy?
A set of conscious and unconscious rules that organize

attachment experiences and act as filters through which an individual interprets relational experiences (Main et al., 1985)
Self – Anxiety
Others – Avoidance (Bartholomew & Horowitz, 1991)

Attachment versus Close Relationships
Secure Base – Exploration
Separation  Proximity Seeking
Safe Haven
Loss  Grief

Measuring Attachment Beliefs

Positive View Low Avoidance Negative View High Avoidance

OTHER

Positive View Low Anxiety

SELF

Negative View High Anxiety

SECURE

PREOCCUPIED

Comfortable with intimacy and autonomy

Preoccupied with relationships and abandonment

DISMISSING

FEARFUL

Downplays intimacy, overly self-reliant

Fearful of intimacy, socially avoidant

Figure 1.Bartholomew’s model of self and other

Attachment and Feelings Secure Attachment Full range Good control Self-soothes Shares feelings OK with others’ feelings

Avoidant Attachment Restricted affect Focus is on control Uses things to self soothe Keeps feelings buried Doesn’t share feelings

Ambivalent Attachment Full range Poor control Can’t self soothe Shares feelings too much Overwhelmed by others’ feelings

Disorganized Attachment Full range, but few positive feelings Poor control Can’t self-soothe Can’t really share with others Overwhelmed by others’ feelings Dissociates

Complex trauma 1) Begins early in development (often within first 5 to 7 years) 2) Involves various forms of traumatic relationship experiences (physical abuse, sexual abuse, family violence, etc.) Most destructive is what is known as “attachment trauma” When attachment trauma occurs repeatedly throughout childhood it sets the stage for a many psychological, emotional, spiritual, and even physical maladies

Traumatic Homes
1) emotionally overwhelmed caregiver. (child cannot achieve

a secure base and therefore is in a constant state of hyperarousal)
2) with no secure base the child struggles with developing a healthy sense of self-esteem.
3) trauma and abuse do not occur every moment of every day, but the threat is always there
4) child is faced with a relational paradox (dissociation and other types of unhealthy coping behaviors manifest in this environment)

diagnostic criteria for PTSD
Criterion A - Exposure to a traumatic stressor.
Criterion B - Re-experiencing symptoms.
Criterion C - Avoidance and numbing symptoms.
Criterion D - Symptoms of increased arousal.
Criterion E - Duration of at least one month.
Criterion F - Significant distress or impairment of functioning.

dosedose-response relationship
Severity of the trauma, in terms of its intensity, frequency, and

duration, is one of the most important determinants of a stressor’s potential to induce subsequent PTSD. Clinical observation and research show a “dose-response” relationship between degree of stress and the likelihood, chronicity, and severity of PTSD symptoms. Specific characteristics of the traumatic stressors are important, such as degree of violence involved and whether sexual victimization occurred.

exposure
Type I: short term, unexpected event, limited in duration (i.e. car accident, rape, bank robbery, etc.), leads to typical PTSD with symptoms of intrusion, avoidance, hyperarousal.
Those with type I exposure tend to recover more quickly


Type I trauma can create a recapitulation of traumatic experiences

from early in life.


Type II: prolonged events (i.e. Nazi camps, Iraq war, etc.), lead to extreme stress…eventual character problems.

traumatic stressors
Qualities of intensity, frequency and duration of stressor severity
Unpredictability and uncontrollability of the stressor
Presence of life threat
Bodily injury
Tragic loss of a significant other
Involvement with brutality or the grotesque
Degree of violence involved, particularly violence of a criminal

nature
Sexual victimization

caring for trauma victims
Intrusive recollections are why people seek treatment
Affect regulation is at core of treating PTSD and other

trauma related symptoms
Conditioned Emotional Responses (external, internal, and relational events)
When traumatic events cannot be appropriately processed people resort to
Avoidance
Dissociation
Tension Reduction Behavior:

Tension Reduction Behavior
becomes addictive (substance abuse, cutting, sexual

promiscuity, self harm, etc.)
Releases endogenous opiods (body’s equivalent to morphine)
Defensive behaviors become overwhelming, not flashbacks

themselves
Right side of brain stays in the now
Left side of brain needs to go back and put story to it

Caring for trauma victims
Encouraging hippocampus to activate.
Implicit memory to explicit memory which activates left





hemisphere and the prefrontal cortex. It’s about the extinction of fear responses PTSD has been called the “disorder of recovery” by Shalev and Briere The amygdala enables the encoding of fear The involvement of the prefrontal cortex has been found to help the majority of individuals recover from acute trauma.

systematic desensitization 1. Exposure 2. Activation of Emotion 3. Disparity—nonreinforcement of CER (feared outcome) 4. Counterconditioning—get them to relax in event (safety) 5. Extinction of CER

“Avoidance of pain is cause of all neurotic pain” – Jung

Two core issues
Capacity of emotion regulation
Ability to mentalize
Traumatized people have trouble with what they feel and why






they feel that way They have psychodynamic conflicts –afraid of intimacy (leads to autonomy and clinginess) The earlier the trauma the more difficulty in skill deficits How you go about helping clients will be determined by where they are in their skills More psychoeducational for secure Insecure don’t know how to know their deficits of intimacy when trying to find a secure base

Attachment-based Therapy
Safety
Education
Containment
Understanding
Restructuring
Engaging